6
Selecting a Treatment Regimen
Table 4. Antiretroviral Regimens or Components That Should
NOT Be Offered at Any Time
ARV Drugs or
Components
(in alphabetical order)
Reasons for NOT Recommending
as Initial Therapy
ABC/3TC/ZDV
(coformulated) as triple-
NRTI combination
regimen (BI)
▶ Inferior virologic efficacy
ABC + 3TC + ZDV +
TDF as quadruple-NRTI
combination (BI)
▶ Inferior virologic efficacy
ABC + ddI (BIII) ▶ Insufficient data in ART-naive patients
ABC + TDF (BIII) ▶ Insufficient data in ART-naive patients
d4T + 3TC (BI) ▶ Significant toxicities including lipoatrophy; peripheral
neuropathy; and hyperlactatemia, including
symptomatic and life-threatening lactic acidosis,
hepatic steatosis, and pancreatitis
ddI + 3TC (or FTC) (BIII) ▶ Inferior virologic efficacy, least clinical trial experience
ddI + TDF (BII) ▶ High rate of early virologic failure
▶ Rapid selection of resistance mutations
▶ Potential for immunologic nonresponse/CD4 T-cell
decline
▶ Increased ddI drug exposure and toxicities
DLV (BII) ▶ Inferior virologic efficacy
▶ Inconvenient (three times daily) dosing
DRV (unboosted) ▶ Use without RTV has not been studied
ENF (BIII) ▶ No clinical trial experience in ART-naive patients
▶ Requires twice-daily subcutaneous injections
ETR (BIII) ▶ Insufficient data in ART-naive patients
FPV (unboosted) (BIII) ▶ Less potent than RTV-boosted FPV
▶ Virologic failure with unboosted FPV-based regimen
may select mutations that confer resistance to DRV
IDV (unboosted) (BIII) ▶ Inconvenient dosing (three times daily with meal
restrictions)
▶ Fluid requirement
IDV (RTV-boosted) (BIII) ▶ High incidence of nephrolithiasis
NFV (BI) ▶ Inferior virologic efficacy
▶ High incidence of diarrhea
RTV as sole PI (BIII) ▶ High pill burden
▶ Gastrointestinal intolerance
SQV (unboosted) (BI) ▶ Inferior virologic efficacy
TPV (RTV-boosted) (BI) ▶ Inferior virologic efficacy
